Background: Current guidelines for the surgical management of melanoma aim to bring a combined consensus approach to the surgery of melanoma. Whether differe nt outcomes for melanoma are related to the specialist who treats the patient is unknown. Objectives: To examine the clinicopathological features and surgical m anagement of patients with primary cutaneous malignant melanoma treated by derma tologists,general surgeons, plastic surgeons and general practitioners (GPs). We also examined if the category of specialist had an effect on the survival outco me for the patient. Methods: A retrospective, observational study of patients re gistered on a specialist database that records the clinicopathological features, surgical treatment and follow-up information of patients with malignant melan oma in Scotland. The patients had invasive primary cutaneous malignant melanoma without evidence of metastasis at the time of surgery, diagnosed between 1979 an d 1997, with follow-up to the end of December 1999. Clinicopathological charac teristics and surgical treatment of patientswere compared for the four groups of specialist, as were overall survival (OS), disease-free survival (DFS) and re currence-free interval (RF). Results: Of 1536 patients, 663 (43% ) were treat ed initially by a dermatologist, 486 (32% ) by a general surgeon, 257 (17% ) b y a plastic surgeon and 130 (8% ) by a GP. The proportion of patients managed b y dermatologists rose over the lifetime of the study. Compared with the other sp ecialists, the patients treated by general and plastic surgeons were older; a hi gher proportion of female patients was managed by dermatologists; median tumour thickness, lesion diameter and frequency of ulceration were all greater in the g eneral surgeon-treated group; plastic surgeons treated a higher proportion of lentigo maligna melanomas; and general surgeons and GPs saw a higher proportion of nodular melanomas. Over 90% of patients managed by a dermatologist or GP un derwent wider local excision following initial excision, compared with 43% and 25% , respectively, in the general and plastic surgery groups. General surgeon s used wider excision margins than the other specialists. OS, DFS and RF were si gnificantly better in the dermatology group comparedwith the general and plastic surgery groups. Conclusions: This study showed that dermatologists manage an in creasing majority of melanoma patients and that there were significant differenc es in the surgical treatment of melanoma between dermatologists and surgeons. Su rvival was significantly better in the dermatology-treated group, suggesting t hat dermatologists should have a central role in melanoma management. Background: Current guidelines for the surgical management of melanoma aim to bring a combined consensus approach to the surgery of melanoma. Whether differe nt outcomes for melanoma are related to the specialist who treats the patient is unknown. Objectives: To examine the clinicopathological features and surgical m anagement of patients with primary cutaneous malignant melanoma treated by derma tologists, general surgeons, plastic surgeons and general practitioners (GPs). Also also if the category of specialist had an effect on the survival outco me for the patient. Methods: A retrospective , observational study of patients re gistered on a specialist database that records the clinicopathological features, surgical treatment and follow-up information of patients with malignant melan oma in Scotland. The patients had invasive primary cutaneous malignant melanoma without evidence of metastasis at the time of surgery , diagnosed between 1979 an d 1997, with follow-up to the end of D ecember 1999. Clinicopathological charac teristics and surgical treatment of patients were compared for the four groups of specialist, as were overall survival (OS), disease-free survival (DFS) and re currence-free interval (RF). Results: Of 1536 patients, 663 (43%) were treat ed initially by a dermatologist, 486 (32%) by a general surgeon, 257 (17%) bya plastic surgeon and 130 (8%) by a GP. The proportion of patients managed by dermatologists rose over the lifetime of the study. Compared with the other sp ecialists, the patients treated by general and plastic surgeons were older; a hi gher proportion of female patients was managed by dermatologists; median tumor thickness, lesion diameter and frequency of ulceration were all greater in the g eneral surgeon-treated group; plastic surgeons treated a higher proportion of lentigo maligna melanomas; and general surgeons and GPs saw a higher proportion of nodular melanomas. Over 90% of patients managed by a dermatologist or GP un derwas another local excision following initial excision, compared with 43% and 25%, respectively, in the general and plastic surgery groups. General Surgeon s used wider excision margins than the other specialists. OS, DFS and RF were si gnificantly better in the dermatology group comparedwith the general and plastic surgery groups. Conclusions: This study showed that dermatologists manage an in creasing majority of melanoma patients and that there were significant differencies in the surgical treatment of melanoma between dermatologists and surgeons. Su rvival was significantly better in the dermatology -treated group, suggesting t hat dermatologists should have a central role in melanoma management.